Basic Information
| Provider Information | |||||||||
| NPI: | 1942286554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROSEY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 572 CANDLEWYCK RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175604200 | ||||||||
| FaxNumber: | 7175606380 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 GRANITE RUN DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176016823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175604200 | ||||||||
| FaxNumber: | 7175606380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OC006143L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 200037025 | 01 | RAILROAD MEDICARE | OTHER |